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Wise Health Professional Corporation

Organization Active NPI Psychiatry Physician · Chicago, IL

NPI 1891969903 · NPPES record last updated Feb 22, 2024

Key facts

NPI
1891969903
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
License
036091776 (IL)
Legal business name
WISE HEALTH PROFESSIONAL CORPORATION
Practice address
1127 N. Oakley Ave
5TH Floor
Chicago, IL 60622-3507
Phone
(773) 989-9868
Fax
(773) 989-9824
NPI assigned
Apr 18, 2008
Organization subpart
No

Authorized official

Name
Dr. Shephali A Patel, M.D. NPI 1063592095
Title
President
Phone
(847) 322-9602

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20081110000517 IL Part B Supplier - Clinic/Group Practice 4789743436 Receives reassigned benefits from 14 practitioners
Practice locations: Chicago, IL; Chicago Heights, IL; Crestwood, IL; Evanston, IL; Northbrook, IL; Skokie, IL; Waukegan, IL; Chciago, IL

National Provider Directory

Tax ID family
Wise Health Professional Corporation (2 organizations share this tax ID)

Locations

1127 N Oakley Blvd
Fl 5
Chicago, IL 60622
Phone (773) 271-9040

1044 N Francisco Ave
#505
Chicago, IL 60622
Phone (773) 989-9868

2320 S Lawndale Ave
Chicago, IL 60623
Phone (773) 522-0400

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X 036091776 IL Yes

Addresses

Primary practice location

1127 N. Oakley Ave
5TH Floor
Chicago, IL 60622-3507

Mailing address

1127 N. Oakley Ave
5TH Floor
Chicago, IL 60622-3507
Phone (773) 989-9868

Other identifiers

IdentifierTypeStateIssuer
036091776MedicaidIL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 22, 2024.

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1891969903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 N. OAKLEY AVE",
            "address_2": "5TH FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223507",
            "telephone_number": "773-989-9868",
            "fax_number": "773-989-9824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 N. OAKLEY AVE",
            "address_2": "5TH FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606223507",
            "telephone_number": "773-989-9868",
            "fax_number": "773-989-9824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE HEALTH PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SHEPHALI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-322-9602",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036091776",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036091776",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

All providers in Chicago, IL · Psychiatry Physician in Illinois

Sources for this page

Verify at the official NPI Registry.